We developed a clinical score to monitor tuberculosis patients in treatment and to assess clinical outcome. We used the WHO clinical manual to choose signs and symptoms, including cough, haemoptysis, dyspnoea, chest pain, night sweating, anaemia, tachycardia, lung-auscultation finding, fever, low body-mass index, low mid-upper arm circumference giving patients a TBscore from 0 to 13. We validated the score with data from a cohort of 698 TB patients, assessing sensitivity to change and ability to predict mortality. The TBscore declined for 96% of the surviving patients from initiation to end of treatment, and declined with a similar pattern in HIV-infected and HIV-uninfected patients, as well as in smear negative and smear positive patients. The risk of dying during treatment increased with higher TBscore at inclusion. For patients with a TBscore of >8 at inclusion, mortality during the 8 months treatment was 21% (45/218) versus 11% (55/480) for TBscore <8 (p< 0.001). TBscore assessed at end of treatment also strongly predicted subsequent mortality. The TBscore is a simple and low-cost tool for clinical monitoring of tuberculosis patients in low-resource settings and may be used to predict mortality risk. Low TBscore or fall in TBscore at treatment completion may be used as a measure of improvement.

Vitamin D does not improve clinical outcome among patients with TB and the trial showed no overall effect on mortality in patients with TB; it is possible that the dose used was insufficient. Clinical trial registered with www.controlled-trials.com/isrctn (ISRCTN35212132).

ObjectivesTo describe the risk factors for treatment delay and the effect of delay on the severity of tuberculosis (TB) in a prospectively followed TB cohort at the Bandim Health Project in Guinea-Bissau.BackgroundTreatment delay in patients with TB is associated with increased mortality and transmission of disease. However, it is not well described whether delay influences clinical severity at diagnosis. Previously reported risk factors for treatment delay vary in different geographical and cultural settings. Such information has never been investigated in our setting. Change in delay over time is rarely reported and our prospectively followed TB cohort gives an opportunity to present such data.ParticipantsPatients were included at the time of diagnosis at three local TB clinics and the national TB reference hospital. Inclusion criteria were age >15 years and diagnosis of TB by either sputum examination or by the WHO clinical criteria. Patients with extrapulmonary TB were excluded.Primary and secondary outcome measuresThe primary outcome was treatment delay. Delay was assessed by patient questionnaires. The secondary outcome was Bandim TBscore as a measure of TB morbidity and all-cause mortality.ResultsA total of 1424 persons were diagnosed with TB in the study area between 2003 and 2010. We included 973 patients with TB in the study. The median treatment delay was 12.1 weeks. Risk factors for delay were low educational level, HIV-1+HIV-2 dual infection and negative sputum smear. TB treatment delay decreased by 10.3% (7.9–12.6%) per year during the study period. Delay was significantly associated with clinical severity at presentation with 20.8% severe TB cases in the low delay quartile compared with 33.9% if delay was over the median of 12.1 weeks.ConclusionsLong treatment delay was associated with more severe clinical presentation. Treatment delay in TB cases is decreasing in Guinea-Bissau.

Bissau has a very high incidence of intrathoracic TB. Human immunodeficiency virus (HIV), increasing age, male sex, ethnicity, adult crowding, family structure, and poor housing conditions were independent risk factors for TB. Apart from HIV prevention, TB control programmes need to emphasize risk factors such as socioeconomic inequality, ethnic differences, crowding, and gender.

Estudo exploratório descritivo, que objetivou conhecer os motivos que levam homens a procurar atendimento de saúde e compreender os motivos que os afastam de uma Unidade Básica de Saúde da Família (UBSF) no sul do Brasil. Pela análise dos prontuários, identificaram-se 175 atendimentos a homens entre 25 e 59 anos em 2010. Problemas agudos acometeram 93 (52,2%) usuários, a dor desencadeou 42 (23,6%) dos problemas crônicos, hipertensão arterial acometeu 37 (21,4%) clientes. Com entrevistas apreenderam-se os motivos de afastamento daquela UBSF. Sentiam-se saudáveis, por isso frequentavam pouco o serviço de saúde, ficando dez anos ou mais sem procurá-lo. Além de questões de gênero, alegaram incompatibilidade de horário, medo de detectarem doença grave, número insuficiente de fichas e falta de especialistas. Para atender às peculiaridades da população masculina, é necessário que os profissionais de saúde se capacitem, problematizem a realidade de cada UBSF e, juntamente com os gestores, vislumbrem e operacionalizem estratégias inclusivas de atendimento.

Previous suicide attempts are an important predictor of both repeated attempts and suicide. This paper presents the profile of patients who had attempted suicide and were admitted to a general hospital in Rio de Janeiro, Brazil. From April 2001 to March 2002, 160 suicide attempts were recorded (68% women; 26% adolescents). Ingestion of pesticides and prescription drugs were the two most common methods used. The two methods had been used by similar numbers of women, while two-thirds of men had used pesticides. As for prevalence of factors associated with attempted suicide, 21% of patients had been in contact with health services within 30 days prior to the event, 28% mentioned previous suicide attempts, and 23% reported other cases of suicide or attempts in the family. Despite the limited data in Brazil, suicide attempts appear to be an important health problem, particularly among youth. Surveillance systems for suicide attempts could help expand knowledge on this problem.

Objective: analyze the knowledge of hospital nurses about the ethical and legal aspects in nursing care for domestic violence victims.Method: qualitative research, involving 34 nurses at two hospital in the city of Rio Grande-RS (Brazil). The data were collected between May and August 2014 through semistructured interviews and analyzed by means of the software Analyse Lexicale par Contexte d'un Ensemble de Segment de Texte, which groups the lexicons with similar roots, constituting the classes according to the function of the words in the text.Results: the class generated two subclasses: the nurses' (lack of) knowledge on the legal competences, in which the confusion between a police compliant and a mandatory report was observed; and (lack of) knowledge on the ethical competences, in which they mention the need for secrecy, advice and privacy in the care process. Continuing education empowers the professionals, which entails the visibility of the violence in the health area.Conclusion: the attention of instutucional managers for training the professionals is necessary. The reified knowledge on the phenomenon, associated with the relational care, point towards humanized and emancipatory nursing care to the victims. DESCRIPTORS: Domestic violence. Violence against women. Ethics, professional. Liability, legal. Nursing care. Professional training. Resultados: a classe gerou duas subclasses: (des)conhecimento das enfermeiras acerca das competências legais; nela observou-se a confusão entre denúncia policial e notificação compulsória, e (des)conhecimento das enfermeiras acerca das competências éticas, em que mencionam a necessidade de sigilo, orientação e privacidade no processo de cuidar. A educação permanente empodera os profissionais refletindo na visibilidade da violência, no campo da saúde. Acosta DF, Gomes VLO, Oliveira DC, Gomes GC, Fonseca AD 2/9 ASPECTOS ÉTICOS E LEGAIS NO CUIDADO DE ENFERMAGEM ÀS Conclusão ASPECTOS ÉTICOS Y LEGALES EN EL CUIDADO DE ENFERMERÍA DE VÍCTIMAS DE VIOLENCIA DOMÉSTICA RESUMENObjetivo: analizar el conocimiento de las enfermeras sobre los aspectos éticos y legales en la atención de enfermería a víctimas de violencia doméstica.Método: investigación cualitativa con 34 enfermeros de dos hospitales de la ciudad de Rio Grande-RS (Brasil). Los datos se recolectaron entre mayo y agosto de 2014, por medio de entrevistas semiestructuradas y analizados utilizando el software Analyse lexicale par Contexte d'un Ensemble Segmento de Texte, que agrupa los léxicos, con raíces similares, formando clases de acuerdo a la función palabras en el texto.Resultados: la clase generó dos subclases: (des)conocimiento de las enfermeras sobre las habilidades legales; se observó la confusión entre los denuncia ante la policía y la notificación obligatoria, y el conocimiento (falta de) de las enfermeras sobre competencias éticas, citando la necesidad de mantener el secreto, la orientación y la privacidad en el proceso de atención. La educación permanente permite a los profesionales que reflejan la visibil...

this study aimed to know the strategies of families in the care of children with chronic diseases. A descriptive and exploratory research was carried out using a qualitative approach, in a Pediatric Unit of a university hospital in the south of Brazil, during the first and second halves of 2013. The study involved 15 participating families. Data were collected by means of interviews subjected to thematic analysis. It was identified as strategies: balance work, study and care, share tasks throughout the day, adapt the physical area of the house, engage the child in their own care, seek resources in the network of social support and faith, seek assistance in another city; and engage in physical activity to reduce stress. It was concluded that it is necessary that the nurses participate of the family support network, as a support source for the strengthening of the family to the care, acquiring skills and expertise to a positive coping of the child's chronic disease. DESCRIPTORS:Nursing. Child. Chronic Disease. Family. Nursing care. ESTRATÉGIAS DE FAMÍLIAS NO CUIDADO A CRIANÇAS PORTADORAS DE DOENÇAS CRÔNICASRESUMO: Objetivou-se conhecer as estratégias de famílias no cuidado a crianças portadoras de doenças crônicas. Realizou-se uma pesquisa descritiva e exploratória, com abordagem qualitativa, em uma Unidade de Pediatria de um hospital universitário do Sul do país, no primeiro e segundo semestres de 2013. Participaram 15 familiares. Os dados foram coletados por entrevistas submetidas à análise temática. Como estratégias foram identificadas: conciliar trabalho, estudo e cuidados; dividir as tarefas ao longo do dia; adaptar a área física da casa; envolver a criança no seu próprio cuidado; buscar recursos na rede de apoio social e na fé; procurar assistência em outra cidade; e realizar atividade física para fortalecer-se e reduzir o estresse. Concluiu-se como necessário que o enfermeiro torne-se parte da rede de apoio da família, sendo fonte de suporte para que a mesma consiga fortalecer-se para o cuidar, adquirindo habilidades e competências para o enfrentamento positivo da doença crônica da criança.DESCRITORES: Enfermagem. Criança. Doença crônica. Família. Cuidados de enfermagem. ESTRATEGIAS DE LAS FAMILIAS EN EL CUIDADO DE NIÑOS CON ENFERMEDADES CRÓNICASRESUMEN: Este estudio tuvo como objetivo conocer las estrategias de cuidado de niños con enfermedades crónicas, realizadas por las familias. Se realizó un estudio cualitativo descriptivo, exploratorio en una unidad pediátrica de un hospital universitario en el sur del Brasil, en 2013. Participaron 15 familiares. Los datos fueron recolectados a través de entrevistas y sometidos a análisis temático. Fueran identificadas las siguientes categorías: conciliar trabajo, estudio y asistencia; dividir las tareas a lo largo del día, adaptar el espacio físico de la casa, incluir a los niños en su propio cuidado, buscar recursos en la red de apoyo social y la fe, buscar ayuda en otra ciudad y realizar actividad física para reducir el estrés. Se concluyó que las enferm...